Sample RCA

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Apr 3, 2024

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Introduction In 2014 a young woman by the name of Erica Byrom was admitted to the Johns Hopkins Bayview Medical Center in Baltimore, Maryland. They diagnosed her with preeclampsia, which is defined by Mayo Clinic as, “A pregnancy complication characterized by high blood pressure” (Mayo Foundation, 2020). Erica’s daughter was viable at 25 weeks, Erica should have been advised that a c-section would have been the safest option for her and her baby. Instead, doctors were not clear in their description of the risks that might occur during natural childbirth over c- section. Due to these circumstances, she chose to forgo a c-section and deliver her daughter Zubida naturally, causing her to have hypoxic brain injury leading to her later diagnosis of Cerebral Palsy. Purpose Statement The purpose of this paper is to inform the reader about a sentinel event that involved a woman named Erica who was diagnosed with preeclampsia during her pregnancy. The doctors and medical staff involved with this case did not give Erica the education needed to make an informed decision about her delivery options. Therefore, Erica believed the best way to deliver her daughter would be through vaginal delivery, causing her to be born with hypoxic brain injury, leading to her later diagnoses of Cerebral Palsy. Background Information Erica Byrom was a sixteen-year-old woman, who was 25 weeks pregnant. At this time in her pregnancy, her blood pressure was dangerously high. During pregnancy, this is known as preeclampsia. There are certain risk factors that mother and infant face when the diagnosis of

preeclampsia is made. According to the article, $229 million verdict for Maryland baby with cerebral palsy, if preeclampsia is undiagnosed or untreated it can lead to seizures, placental abruption, and poor blood flow to the placenta (Cline, 2021). The only cure for preeclampsia is to deliver the baby through a cesarean section, also known as a c-section. In the case of Erica Byrom, doctors at Johns Hopkins told her that her baby has a small chance of being born alive or unharmed (Cline, 2021). With this information, Byrom refused to have the c-section, because she believed that her baby would have a better chance of survival through natural delivery. Doctors did not advise her otherwise, leading to her daughter to be born with brain injuries that would later lead to Cerebral Palsy. Problem Statement Erica was misinformed regarding her condition and the effect that it could possibly have on her unborn child. The doctor led Erica to believe that vaginal delivery was the best and only option for her, or her child would die. Those involved should have notified Erica that with her condition of preeclampsia, the safest option would be to deliver her child via c-section. Due to lack of education, Erica and her unborn daughter were placed in danger, and at risk for death. Plan of Action In the medical profession, there are certain ethical principles that should be followed in a scope of practice. One ethical principle that was not adhered to was beneficence which is defined

as, “care that is in the best interest of the client” (Holman et al., 2019). The doctors and physicians at Johns Hopkins Bayview Medical Center did not focus on the care that was best for the client or her unborn child. Instead, they avoided their duty of ethics, and allowed for this malpractice to occur. However, clients are allowed to refuse certain medical procedures or care they do not wish to receive. In the case of Erica, she was not given accurate information to be able to forgo the decision on a c-section. According to the article, Management of pregnant patients who refuse medically indicated cesarean delivery, “Under the following conditions a physician might consider actively challenging a woman on her decision: the fetus will suffer irrevocable harm without treatment, the treatment is clearly indicated and likely to be effective, and the risk to the woman is low” (Deshpande & Oxford, 2012). With this in mind, the Johns Hopkins Bayview Medical center could have strongly encouraged Erica to have the c-section, as the fetus was at risk, the treatment of c-section for preeclampsia is effective, and the risks to Erica were very low. If after all these things were discussed and Erica still refused to have the procedure, those on Erica’s care team could have gotten a court order as a last result. However, it is clear the team at Johns Hopkins did not abide by these standards of practice, leaving both Erica and her baby at risk. If these procedures were followed, the problem could have been avoided. QSEN Measures Safety is a main concern when dealing with any patient. In the case of Erica, the Johns Hopkins Bayview Medical Center did not hold safety high on their list. The concept of safety is to promote safe and quality care while reducing risk factors (Holman et al., 2019). Erica’s quality

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of care was lacking. The team did not keep the safety of Erica or her child in mind when they allowed her to refuse the medical recommendation to have a c-section. Evidence based practice is a great tool to use in healthcare. From evidence-based practice, we can learn new knowledge through research that allows us to better care for clients and produce better patient outcomes. Evidence based practice in this case stated that to cure preeclampsia, a c-section must be done for the health and safety of mother and baby. The team at Johns Hopkins disregarded evidence-based practice, by allowing Erica to have a natural birth, putting both at risk. Patient centered care is something that should always be followed in the healthcare profession. Focusing on the patient and delivering the best care we can is beneficial to the healthcare team and the patient at hand. Patient centered care is known as “The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, and spiritual and cultural needs, preferences and values” (Holman et al., 2019). In this case, the staff at Johns Hopkins was not focused on the aspect of patient centered care. Instead of stating the risks of natural delivery with preeclampsia, Erica was told by a doctor that her baby “would likely die or suffer brain damage” (Cline, 2019). This is a harsh and inaccurate description of what would happen to Erica’s child if a c-section was performed. This statement made by the interdisciplinary team did not foster the needs of Erica, nor her child.

Summary Johns Hopkins Bayview Medical Center mislead their client Erica Byrom by giving inaccurate information regarding pre-eclampsia and the recommendation of a c-section. In doing so, this lead to Erica making the decision to have a natural birth, causing her daughter to be born with hypoxia of the brain, leading to her diagnosis of Cerebral Palsy. The staff at Johns Hopkins could have made the executive decision to go against Erica’s wishes, advising her to go against her plan of natural delivery; however, they did not do so. The negligence shown by the staff at Johns Hopkins is clear, as they avoided safety, evidenced based practice, and overall patient centered care.

Sample RCA

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